Tuesday, June 28, 2011

With only a few opportunities to get out hiking until the end of July, I decided to run down to Medford for the night and take a shot at Mt. McLoughlin on Monday. McLoughlin is the 16th highest mountain in Oregon with an elevation of 9,495'. The trailhead elevation is around 5,575', and its approximately 5.5 miles to the summit. Last road reports had been sketchy weather or not the roads were open, but from the date of the last report it looked like it would be doable. I drove down to Medford Sunday afternoon after work and stayed at a hotel, leaving about an hour of driving to reach the trailhead.

I should have gotten moving earlier, but didn't get going until a little after 7am, reaching the trailhead around 8:20. I didn't think the insects would be so bad right now, so I didn't bring any repellant, but I was wrong. I've never seen mosquitoes that thick in my life. I quickly geared up and got moving, thinking that once I was hiking it wouldn't be that bad. I was wrong, they stayed in a swarm around me all the way up to 7,000'! Even though the roads were open, the trail was in horrible shape. The snow pretty much started at the parking area, even though it was broken and the trail was still discernible. That lasted for about a mile, then the trail was lost. About this time I tied in with a group of four skiers and we set out on some route finding. One of them had already plotted a few map points in his GPS, so we were able to steer toward the SouthEast ridge. After another mile or so, it was just a free for all, either find old tracks or head straight up.

Again, I over thought and over geared myself, such as bringing snowshoes when I didn't need them. It was also a very warm day. so I was sweating fairly heavy and trying to keep hydrated, but even that was a challenge. I kept going for several more hours, but I was becoming increasingly exhausted. Around this time, there was a front rolling through, and the weather didn't look like it was going to hold (forecast was for thunderstorms Tuesday), so I stopped at 9,200' and made a decision to turn back. At my current rate of progress I was only making 200-300' per hour anyway at last count, so one more hour up could put me into foul weather or darkness on the descent. Coming down should have been a breeze, made great time glissading down the steeper snow fields. Problem arose back in the tree line. The snow melt had obliterated most of the tracks from earlier, and one exhausted bad decision put me to the West side of a ridge, so I had to make a hook back East to reach the car, probably adding another mile or so to the hike.

Made it back to the parking area around 7pm, right when the skiers had returned. They'd summited and skied off the North side to where they had left another car, so after a quick chat and snagging some insect repellant, I threw my gear in the car and headed out. Within minutes of pulling out of the parking lot, a torrential downpour started, so it was a good call to get out of there when I did. Notes for next climb, lighten the pack, bring insect repellant, and remember to reapply sunscreen. I sunblocked before heading up, but with sweating heavy and not realizing how long I'd be on the mountain, my face ended up a little fried. All in all, it was still an awesome climb. I know now that with a snow free approach to McLoughlin, or even the Three Sisters, I can make the summit. 4 miles of mixed snow conditions, 3,625' of vertical gain, and still packing too much gear, the 9,200' mark was still pretty impressive for the ex-smoker who's lived most of his life between sea level and 500'.

Monday, June 20, 2011

After taking the Remote Medical International Wilderness First Aid course back in February, I found myself craving more education and information. The next logical step was to look for a Wilderness First Responder course, and who better to train with than the group I started with. I was lucky enough to be able to get time off from work and have a place to stay (thanks to my sister and brother in law), so I ended up in Seattle for 10 days training with RMI. Since the WFA class, I'd been studying on my own time with the Medicine for Mountaineering book and a few other selections, as well as my RMI booklet and notes. Right from the first day, I knew that I'd made a wise choice. The instructors for the WFR course were just as knowledgeable and with as diverse backgrounds as the WFA course.

The ringleader of the instructors was Kate Earle ("Another bad analogy!") who comes from an EMS background as well as being a world traveler and spending several years in the Peace Corps. Working with her was Phoebe Robinson ("No you cannot improvise that!"), who is an ER nurse and EMT with an extensive outdoor background . Rounding out the instructors for the first few days was Carrie Parker ("Oh my gosh dude! You just fell out of your rocketship! Are you ok?") who spent time as a paramedic in Las Vegas as well as being a mountaineering guide and rock climber. There is no way I could really sum up the experience, knowledge and backgrounds of the instructors, other than to say they are all amazing. From the very beginning they started training us using the same format I was already familiar with from my WFA class but now the information was being expanded on and much more in depth.

Day one consisted of defining wilderness medicine and going over the steps of primary patient care. The steps of the patient assessment were the same as the WFA class, but now they were being expanded upon. An example was in assessing vital signs, in which we learned the first day how to take a blood pressure reading. I've had it done to me hundreds of times over the years, I've seen it done hundreds of times. That day was the first time I actually did it myself, and even though it could be considered simple and routine by people in the healthcare field, to me that was a milestone! Now the process was starting to become more clear to me, these steps that were taught to me were now being expanded and explained further so as WFR's, we would be able to gain a clearer picture as to what was happening with our "patients".

Day two we started with a bit of review, just to see if we were retaining information, then on to CPR. If you haven't taken a CPR/AED class in the last 6-8 months, I highly recommend it. The protocols have change drastically, and if I hadn't taken a basic class in February, it would have all been new information to me. After CPR we transitioned to thoracic injuries, and followed the standard format: lecture, demonstration, scenario. That's what I find the most beneficial in learning emergency medicine. You can read a book on wilderness medicine, or even urban emergency medical, and unless you work hands on, you aren't going to understand fully how it all works together. If I was in the roll of the healthcare provider, I would always ask my "patients" how I was doing, was I thorough, did I miss anything, and what could I improve the next time. I've had experience with traumatic accidents over the years, and although I knew "some" first aid, I really didn't know near enough. In the "if I only knew then what I know now" scheme of things, I would have acted much differently.

We spent the next few days working through trauma scenarios, spinal injuries, and working in teams. After day three, Carrie had to leave to instruct at the RMI W-EMT class, so it was Kate and Phoebe for most of day four. It also happened to be one of the long days in the course, we were working in to the evening to all spend time on different techniques and to have some direct evaluation from instructors. After returning from a dinner break, the instructors brought with them Dee Allen, who was one of the instructors from my WFA class. It was a nice surprise to see her again, and when it was my turn to be evaluated, I ended up working with her. Up to this point, we had only been covering injuries and not illnesses, and my training partner had brought that up to Dee with a few questions. To make things interesting, when it was my turn to evaluate, she threw me for a loop by giving me a medical case instead of trauma. I had to shift my whole approach and assessment because of it, but with knowing what Dee had taught me in my previous class, I went down the medical side of the assessment triangle until it was getting too late to finish completely. She gave me valuable feedback, and told me I was doing good and was very thorough.

By Tuesday, I think everyone in the class was feeling a little overwhelmed, but I could see us all having that moment where everything started to click. Even with differing personalities, we started developing teamwork and leadership skills, but at the same time knowing when to be subordinate and let the leader do their job and lead. That was also when I received another surprise when Kate Peters from the WFA class came in to instruct. She also has a varied outdoor and urban background with powerful teaching skills. All throughout the progression of the lecture and scenarios, I was getting great feedback and encouragement from Kate Earle and Phoebe. Their lecture skills make you want to take in everything they have to say. The legal pad I brought along on day one may have had 3/4 of its pages blank when I showed up. Tuesday night on my way home, I had to stop and pick up another because of the extensive note taking I was doing through the lectures. After class concluded for the day, I spent a few minutes working with another student before finally heading out, with the promise of a much needed day off on Wednesday. 80 hours of training in a 10 day period is a touch on the intense side.

A smarter person may have actually taken a break and rested, but not me. I decided to head on out to Mt. Si and going hiking before getting another 5-6 hours of sleep and heading back to class Thursday. Day six we started discussing mass casualty incidents and triage, but also began working more into medical issues, illnesses and allergies. The high point of the day was when we reach medication administration. The lesson was how to administer an intramuscular injection of epinephrine on a patient suffering from anaphylaxis, which in a remote setting may possibly fall under our protocols. First and foremost, we had to learn and recite the 5 R's of medications: Right patient, right medication, right date, right dose, right time. Then we took turns injecting each other in the arm with sterile saline. Everyone stayed conscious, and no one screwed up..... it was a good day! Only real downside of the whole class for me started about the end of Thursday when I started catching a cold. The stress, lack of sleep, physical exertion, and sleeping on an air mattress in a house with pets was taking its toll.

Friday was the day of our mass casualty drill. We spent the earlier part of the day recapping mass casualties, and triage, but then spent the better part of the day on environmental issues such as hypothermia, frostbite, heat illness, dehydration/hyponatremia, drowing/submersion, and began to touch a bit more on psychological issues that someone way encounter. We broke for dinner around 5p.m. after a quick planning session to appoint our incident commander and begin designating roles for rescuers. We started filing back in around 7p.m., and were allowed back into the classroom while the instructors took the "victims" out into the park to set the scenario into motion. At this point, none of us know what we're in for. It could have been a bus going off a mountain road, a group of ill Boy Scouts, we had no clue.

After 8p.m., we were given a radio call of a floatplane crash in the park. Again, an event I know all too well, having lost a few friends over the years and having other friends survive crashes, it hit close to home. After finding the "crash site", we began assessing patients and doing what we were trained to do. I ended up with one of the worse off of the patients, someone who in real life probably would not have survived. I just had to do the best I could, try and keep him calm and comfortable, and wait for the IC to make the call. Around this time, Kate Earle walks by and tells me quietly that in 5 minutes I'm going to go into hypoglycemic shock and to see if the other students would see it happen, how the would react, and if they could diagnose correctly. You are taught that if one of your fellow rescuers goes down, that they become a priority. I have to say, my classmates did a fantastic job. They assumed I'd fallen, so it took a few minutes to get to my "medical history" to find that I was "diabetic", then they grabbed glucose from someones pack for me. I was back in the scenario. By this time someone else had taken over caring for my patient, so the IC grabbed me and had me start helping him decide who was going to be evacuated first, and shortly thereafter we were informed that the exercise was over.

It was an insane experience, but I think we did a phenomenal job. Given that some in the class had no medical experience or their training was years if not decades ago, we gelled as a "Team" and organized a great response to what would be a horrific incident. There was much hugging and hi-5ing going on as we all left for the night, everyone physically and mentally drained, heading home for much needed sleep and the promise of an extra hour of sleep the next morning. Saturday started with a recap of the previous night, some discussion of rescuer stress and critical stress incident meetings, terminology, dental emergencies, as well as envenomation. In the afternoon it was a review by playing a game of WFR Jeopardy, which I don't think my team won, but maybe placed second....I still never heard the final score.

Sunday was test day. I'd spent the night before reviewing my notes and preparing the best I could. At the beginning of testing day, we were asked if any of the group would want to volunteer to do the practical first to speed up the day, and for some strange reason I raised my hand. The practical was the part I was most worried about! I had this feeling "of impending doom" (have to use that in humor) that I was going to screw something up bad. Other than sweating profusely from wearing my hoodie with a face mask to keep my "patient" from getting sneezed on, I was told I passed and did an excellent job of assessing my patient. There was a few mistakes made in the order of exam steps, but I didn't miss anything and was thorough. Then it was back in to take the written test, and here I had a moment of panic. As I started reading the questions, I had, for the lack of a better term, a brain fart, and had to kick my brain back into gear. It went well, though, only missing 7 questions for a 93% score. That's a number I can be proud of. I made it through 10 days of intensive, hands on training, knowing the fact that now I have a greater responsibility to help those who are injured or sick, but have better skills and decision making criteria than I had before. Of course it doesn't stop here. Now that I'm back home, I've already had a talk with my local EMS about volunteering once we can show the state that the 80 hour class I attended will satisfy the states requirements. I want to eventually work my way into an EMT program, followed by more training with RMI to learn even more skills.

I will say this to anyone who spends any amount of time in the backcountry, the WFA and WFR classes are more than worth it. People get complacent when they think "Oh, I'll just call 911 and the paramedics will show up", when in reality it could be hours or days before help can arrive in some cases. Having the skills to keep yourself and others alive is worth the class time regardless of who you take a course through. I will push for and advocate that you do train with Remote Medical International, not just because I have and wrote positive statements, but because these people live this and experience these situations regularly. They bring a hands on, "I'm telling you this because I've been there before" way of teaching. They are climbers, mountaineers, guides, rafters, and expedition members. They've seen the things they teach firsthand, and they love what they do.

Saturday, June 18, 2011

1. Its extremely difficult to practice unconditional positive regard in the city. When I'm hiking, its way easier for me to yield on the trail going downhill and exhausted thinking to myself "they'll understand when they're exhausted and heading downhill" Vs. Trying very hard not to lose it when you keep dealing with people that don't understand merge, speed limits, all-way stops and turn signals.

2. People in the backcountry generally have a smile, look of contentment or determination on their faces. In the urban setting, people look pissed off most of the time and view anyone randomly smiling as "not quite all there" or possibly dangerous.

3. As I step out of the shower, I think about all the modern marvels of convenience in the urban setting, and how I love nothing more than to head to the backcountry and shut my phone off while sitting on a rock with no one around for miles.

4. In the urban setting, people type out their thoughts and broadcast them around the world at phenomenal speed. In the backcountry, they sit around the camp site and talk face to face with their voices only broadcasting around the valley. Their laughter may travel a little further.

5. There are many skills you learn and practice in the backcountry you will never use in an urban setting. There are some skills you will learn and practice in an urban setting that you hope you NEVER HAVE to use in the backcountry. (Yep, I just finished my WFR class)

Wednesday, June 15, 2011

Today's hike was a little different than others in the fact that I spent more time enjoying the journey itself and took more time to take in the view. I tend to be in a Zen mode on the ascent, not thinking of anything, not paying attention to the surrounding area......I'm so fixated on the trail and reaching the summit or what ever goal I've set for myself, I miss the journey all together. Prime example was on the descent today, I didn't realize that about 50 yards of trail had a railing. I was so intent on the journey up, my mind didn't even register the fact. There have been moments on return hikes where I almost wonder if I'm on the correct trail since it looks so different on the return. Today spending time hiking with George and Brad kind of broadened my view of the area, as well as taking time at the summit to look around and enjoy what I'm seeing, rather than just feeling the satisfaction of reaching the top. My Zen meditation mode of clearing my head is fine, but I need to learn how to widen my focus to truly enjoy the trip.

The opposite is true when I'm descending a trail, I kick into a strange self analytical mode when I'm heading downhill. Its as if everything I've pushed from my mind on the way up comes flooding back with a vengeance on the way down. Lately its been an internal struggle with the duality of the human mind, and these days its been my own. I come from an agricultural and logging background, and learned from a young age to be an "outdoorsman", a hunter-gather way of thinking. Growing up I learned how to hunt and fish, survival and navigation skills, and how to live off the land. That was the way I wanted to be growing up, it was a lifestyle that suited me. In one way or another, most of my life and livelihood has revolved around timber and agriculture. My grandfather on my moms side was a farmer and later a logger, my dads family had a farm until my grandfather on that side passed away (well before I was born). My own father worked as a forester with the USFS for 30+ years in the timber department. I grew up looking at the forest as a great resource, that if properly managed, would bring prosperity to small communities and much needed goods to the rest of the country. Key words here is properly managed.

As time moved on, I could start seeing that things were not always what they seemed. In the late 80's, we moved back to Alaska, because most logging on Federal land was being shut down and closed off by these "crazy environmentalists" that I thought were ruining it for the rest of us. Years go by, the same situations start working their way North, and I kept feeling this anger toward those that threatened my livelihood buy "shutting down" the timber industry. Then I gained some clarity when the Ketchikan Pulp Mill shut down. It was more about greed than anything, greed on the corporate end of things, and in the process, thousands of people were hurt. It wasn't the environmentalist shutting down the timber, it was corporate greed overstepping its bounds. It came around again when a group bought up the KP mill properties to bring a veneer mill in, promising to revitalize the timber industry in the area. That ran for about a year and shut down, most of the executives lined their pockets with local tax dollars and federal subsidies, and put people out of work again.

Now that I've seen these thing happen, and have seen the small family companies get hurt in the process, I begin to find the internal conflict in me. My dad and my grandpa are my hero's, they shaped who I am today. I then find that I have two historic figures I look up to, and this is when I see my duality because of the two being mortals enemies: Gifford Pinchot and John Muir. I look up to Pinchot as the man who opened up the West, in his effort to provide the greatest good to the greatest number. Then I see what Muir was saying the whole time......... its a handful of peoples greed that could destroy it for the majority of the population. I see both as I hike along through the forest, if it wasn't for one of them bringing about the building of roads into the wild areas to bring out the natural resources, then I wouldn't have the access to those places today. I also see what mismanagement and greed brings to the table, but along with it the ridiculous notion that shutting it off from everyone is the right answer. Where do we find the balance, or do we ever?

I've been up in the Seattle area for about a week now taking the RMI Wilderness First Responder class, and today was a day off from the course. I was supposed to be meeting with some friends that were down from Alaska and when I didn't hear from them today, I decided to go hiking. In the class, one of the instructors (Kate E.) likes to use Mt. Si as the background for some of our training scenarios. Not knowing anything about Mt. Si before arriving in Seattle, I decided to to take a hike up what I've started calling "The mountain of medical mystery"......yeah, bad humor, but at least I didn't find anyone sprawled out in the middle of the trail.

Just a little snippet about Mt. Si and the trail, it is located near North Bend, Washington with an elevation of 4,167 feet. The trail to the spot called the "haystack basin" is 4 miles one way with an elevation of 3,900', which is where most people hike to. From there to the haystack is a bit of a gnarly rock scramble to the summit. I only went as far as the basin since it was not recommended to do the scramble if it was rainy or foggy, which it was both for most of the day. I left Seattle around 2:00pm and headed east on I-90 arriving at the trailhead around 3:00, which sits at around 700'. I was shooting for a pace of around 2mph, but with adding more weight to my pack, i wasn't able to hold it for too long. Working into a steady rhythm, I made decent progress, stopping frequently to adjust gear, drink water, and rest. Along the way I ran into several other hikers (its one of the most popular trails in Wa.), and most would say hi as they passed. I stopped about halfway up to take a break for some food, and had a descender stop at the switchback with me and visit for a few.

Around that time, a father and son team with some ridiculously large and heavy packs came along, and as I would find out later, they were training for a climb of Mt. Rainier coming up next week. After playing leapfrog and visiting along the way, we sort of just worked into a traveling group, talking at rest and encouraging each other up the trail. I stayed with them up to the haystack basin, and then sat with them for about 15 minutes before they left. As they were leaving, we made some introductions and talked about possibly running into each other on Rainier next Monday. A few more people made it up around that time, and I spent a few more minutes visiting and getting pictures. When I'm hiking solo, I'm so fixated on the goal, I lose the enjoyment of the trip and the goal itself by leaving after too short of time. At around 6:30, it was time to head down.

I wanted to try and keep a pace of around 3mph on the descent since I tend to let gravity do its thing. That's never good, and I usually end up with aching feet and knees at the bottom. This time I kept it just under 3mph, reaching the parking lot by 8:00pm, with the only complaint of a little pain in my right big toe and knee. The knee was to be expected, the toe I think I need to get better laces for the Lowa's. They seem to stretch and loosen up, but other than that, it was all muscle fatigue by the time I got to my car. I felt pretty damn good, doing an 8 mile round trip with about 3,200' of vertical in 5 hours. To date, that is the most vertical gain I've achieved in one day, and it wasn't near as taxing on my body as my South Sister attempt from last year. I'm getting so ready for a shot at the Three Sisters or Mt. Adams this year, I just need to have the time and hope a few more roads start opening up, and I'll be on my way up, higher and further.